Provider Demographics
NPI:1366445116
Name:ESHELMAN, ORVAL MYRON (MD)
Entity Type:Individual
Prefix:DR
First Name:ORVAL
Middle Name:MYRON
Last Name:ESHELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:14981 NATIONAL AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2600
Mailing Address - Country:US
Mailing Address - Phone:408-358-1256
Mailing Address - Fax:408-358-1826
Practice Address - Street 1:14981 NATIONAL AVE
Practice Address - Street 2:STE 3
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2600
Practice Address - Country:US
Practice Address - Phone:408-358-1256
Practice Address - Fax:408-358-1826
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA20441207NI0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20441OtherSTATE LICENSE
CA770494064OtherTRICARE
CA010061395OtherRAILROAD MEDICARE
CA004643OtherHEALTH NET
CA00A204410OtherMEDICARE ID
CA00A204410OtherBLUE SHIELD
CA004643OtherHEALTH NET